RESUMO
AIMS: This paper reports findings of a qualitative study whose focus is health services use among individuals with chronic illness. DESIGN: Qualitative research with an ethnographic orientation. SETTING: A low income neighborhood of Guadalajara, Mexico. SUBJECTS: Twenty subjects selected through a theoretical sample. Measurements and main results. Open-ended interviews. The data were content-analyzed. Most diabetic sufferers live with two or more chronic illnesses. Medical services use is combined with that of other healing systems. Participants also combine different types of health care services. Four health care use categories were found: frequent, occasional, periodical, and abandonment. Those who use health services frequently have oscillating or deteriorating illness trajectories, are supported by family members and are primarily women and elderly/retired men. Those who abandon health services have stable trajectories, they are their families primary providers, and cannot stop work to receive medical care; but some others have deteriorating illness trajectories and their symptoms do not ameliorate with consultations. CONCLUSIONS: Different factors explain patterns of health services utilization. Such patterns of use have serious implications in the health care reorganization.
Assuntos
Diabetes Mellitus/terapia , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Idoso , Diabetes Mellitus/etnologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-IdadeRESUMO
The mass media are recognized by many social scientists as important sources of medical information for lay people and as a positive influence on those working in the health care professions. However, there is a lack of study about print and mass media reporting on major health problems in developing countries such as Mexico. This article presents the findings of a study conducted to identify specific messages that the Mexican print media convey to the general reader about chronic diseases, especially one of the most important and pervasive, diabetes. We undertook a comprehensive review and content analysis of secondary source media reporting in the Boletin (Bulletin)--published by the Department of Education and Health, Universidad Autónoma Metropolitana, Xochimilco. The Boletin summarizes all articles related to health matters published in 12 national daily newspapers and 3 magazines. Our study covered all issues of the Boletin from 1992 through 1996. Our findings indicate that at times the press and popular print media disseminate an incomplete and often biased picture of chronic diseases prevalent in Mexico. Specifically, the press gives equal or more important coverage of acute diseases, or to AIDS, than to other major chronic conditions. The press also reproduces the biomedical model of disease and does not address topics important to certain segments of the population, including the patient. Moreover, the media may present an overly idealized impression of the capability of health services. Consequently, this failure to address the issues of certain widespread, chronic illnesses is severe enough to ask about the role of the press in medical health care reform. We conclude by suggesting areas for further research.
Assuntos
Bibliometria , Doença Crônica/epidemiologia , Jornalismo Médico/normas , Humanos , Serviços de Informação , Meios de Comunicação de Massa , México/epidemiologia , Controle de Qualidade , Estudos RetrospectivosRESUMO
This paper reports partial findings from a broader study on the experience of people with chronic diseases. The objective was to explore the perspectives of diabetic patients towards medical care. A qualitative study was conducted in a poor neighborhood of Guadalajara, Mexico. Thirty subjects with diabetes mellitus participated in the study. Data was gathered by open and semi-open interviews in the subjects' homes and over the course of one year. Data were analyzed using a combination of content and conversational analyzing techniques. Three perspectives predominated when participants evaluated medical care: some define it as good, some as ambivalent, and the rest as bad. These perspectives were closely linked to their disease experience and available medical options according to their material resources. These perspectives change with time, are specific to each available service and type of medical care, and are constructed in terms of all the subjects' present chronic illnesses. Those treated through the social security system evaluate the care in negative terms, with the opposite occurring with those treated in public health care centers and private facilities. Implications regarding health care reform are discussed.
Assuntos
Atenção à Saúde , Diabetes Mellitus , Setor de Assistência à Saúde , Satisfação do Paciente , Adulto , Idoso , Atitude , Doença Crônica , Diabetes Mellitus/psicologia , Diabetes Mellitus/terapia , Feminino , Instituições Privadas de Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Previdência SocialRESUMO
The illness experience is a relevant issue in current research and academic discussions. A growing number of research initiatives have undertaken to account for the subject's perspective and subjectivity in the health field. This paper discusses our research team's approach and results in studying the experience of people living with chronic illness. Our perspective is based upon the production in this relatively new field as well as health-related discussions in Latin America. The illness experience calls for an understanding of it as a subjective and existential phenomenon, entailing the phenomenological arena, immersed in the process where ill people "produce" and "reproduce" themselves. The unfolding and course of the illness as well as treatment management are some salient dimensions we evoke. Some lines of future work are presented in order to create a research agenda, highlighting its implications for existing proposals pertaining to health reform in our Latin American countries.
Assuntos
Doença Crônica , Pacientes , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Pesquisa , Papel do DoenteRESUMO
This article examines the relationship between sociodemographic factors and sources of support in non-insulin dependent diabetes mellitus patients living in a socially deprived area of Guadalajara, Mexico. A total of 121 diabetic subjects and the same number of caretakers, spouses and children, participated in the study. Findings show that some variables of diabetic individuals are associated with caretakers' age, sex and kinship. Moreover, sex distribution of children and family composition were also associated with sources of support. No association was found between disease characteristics and those of caretakers. The impact of these results on health services programs is discussed.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Apoio Social , Adulto , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Áreas de Pobreza , Fatores SocioeconômicosRESUMO
A cross-sectional study was conducted to investigate the prescription patterns of general practitioners for non-insulin dependent diabetes mellitus patients in Guadalajara, Mexico. Two hundred and forty medical prescriptions were evaluated. These were indicated by 16 primary care physicians. Results showed that physicians prescribed pharmacologic agents in 93 per cent of the cases, dietary control in 73 per cent, and physical exercise in 48 per cent. A combination therapy of these three measures was employed in 40 per cent of the patients, but the combination regimen of diet and exercise was given only to 3 per cent of the patients. Data showed significant differences in prescribing patterns according to gender of physicians; male physicians prescribed the three measures by more than 10 per cent; On the contrary, female physicians prescribed the drug as the only therapy 27 per cent of the time. The proportion of prescribing diet and exercise measures increased with more years of professional experience. These observations support the findings that prescription patterns by primary care physicians do not meet the criteria currently recommended by international committees for diabetes therapy. We discuss some implications for the metabolic control of the disease and the quality of medical care.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Prescrições de Medicamentos , Atenção Primária à Saúde/estatística & dados numéricos , Distribuição de Qui-Quadrado , Terapia Combinada , Diabetes Mellitus Tipo 2/epidemiologia , Dieta para Diabéticos/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Escolaridade , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Humanos , Masculino , México/epidemiologia , Fatores Sexuais , População Urbana/estatística & dados numéricosRESUMO
This paper reports an evaluation of the risk of tuberculosis infection in school children in the sanitary jurisdictions of Jalisco, Mexico. It also compares the official figures of incidence of smear-positive pulmonary tuberculosis with those estimated with this epidemiological indicator. The study included 6,469 first grade children, six to seven years old, from 95 state schools. We skin-tested 4,260 of them with 2 TU PPD. Sixty per cent of the children tested were vaccinated with BCG. This proportion varied between the jurisdictions: from 43 per cent in Tepatitlan to 70 per cent in Ameca. The rate of tuberculosis infection was 6.3 per cent, with differences between children with a BCG scar and those with no scar (7.4% and 4.4%, respectively). We also found differences in the annual risk of infection between the jurisdictions. The annual risk was 0 per cent in Lagos de Moreno and 1.60 per cent in Ameca. With the exception of two jurisdictions, the incidence of smear-positive pulmonary tuberculosis estimated with this indicator is several times higher than that officially reported.
Assuntos
Tuberculose/epidemiologia , Vacina BCG , Área Programática de Saúde , Criança , Humanos , Incidência , México/epidemiologia , Risco , Tuberculose/prevenção & controleRESUMO
This work analyzes the findings of a study about the incidence of four mental disorders in a zone of the City of Guadalajara's metropolitan area in the Mexican State of Jalisco. The results show the highest rates belong to depression and aggressive conduct (463 and 489 in 1,000 children). Besides, there were some differences related to their sex and their families income.